Laserfiche WebLink
rn. E..ror..e <br />e�rr or <br />everett <br />BUILDING DEPARTMENT <br />259�8745 � <br />❑ GEMOLITION kI� <br />n6� � � !a S �L� <br />R DESiONER <br />(•� � <br />S��PPLICATION FO�. ' <br />CONSTRUCTION <br />PERMIT <br />TO BE COMPLETED IN INK - PLEASE PRINT <br />COMBINATION ❑ BUIIDIN(3 ❑ MECHANICAL <br />MML��ORESS � GITY / 21P <br />51 / � 2.�i�. %s,!' .9'l.�<<i:' �tin.n,....,.( :J��z. <br />21P <br />❑ PLUMBING ❑ :iIGN <br />PIIONE �/ <br />: �4-< ;;��r/ <br />�t �"1. , �r. !t. / i �� �, a hl'r /7:^x Ss �•;.,�. <br />I OF WONk <br />NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILOINO REIOCATlO�I <br />� I HEREBY CERTIFY THAT I HAVE REAO AND E%AMIN�_D THIS AP• <br />PLICATION AND KNOW THESAME TO BE TRUE ANDCORRECT. ALL <br />o`won�n�/cNrouneorie`v_ PROVI310N90FLAW3ANDORDINANCESOOVERNINi3TH19TVFE <br />[L�u(!!'/ � /�`-ad • OFWCIRKWILLBECOMPLETEDWITHWHETIIERSPECIFIEDHEFE• <br />IN OR NOT. THE 6RANTIN4 OF A PERMIT DOE9 NOT PRESUR!E TO <br />pIVE AUTHORITV TO VIOLATE OR CANCEL THE PROVISION3 OF <br />� ia lt�� � C� .S ANYOTHER STATE OR LOCAL lAW RE6ULATINO CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIaN�TUHE OF CONTp�CTOR OR AUTHORI2ED AGENT pATE <br />i <br />X .�.c;�,,.. � � �:. vr <;,� _ , <br />� �2 � � -�_ . �'_ �!' <i'% <br />� �. �.� , <br />, �PVUC�NT9 CIfY BUSME59lILENSE NO <br />P. <br />T <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />•aorn sereecK <br />USE 20NE � u / <br />� <br />iYP[ O� LO�15t <br />�-h� <br />%a7 U � <br />E� <br />� �� �� � 1 <br />RNGYGROOV <br />1F'- 3, <br />I <br />U , <br />V�C�NT SIfE <br />f�YES ONO <br />NO.OF OWEt <br />I <br />�l- �� I L.c. <br />��7 �a�;� <br />FEES <br />BUILDINO <br />PLUMBIN6 <br />MECHANICRL <br />OT41ER <br />PENALTY <br />TOT�L <br />FEE <br />FEE"7 •�\,_�` RECEIPINO �/r�`�(I <br />� �I,� < <br />VAlU11TI0N FEE <br />: <br />